Luke O. Hansen, MD, MHS; Robert S. Young, MD, MS; Keiki Hinami, MD, MS; Alicia Leung, MD; Mark V. Williams, MD
Acknowledgment: The authors thank Linda O'Dwyer, MA, MSLIS, for assistance in the development of the initial database query for this review.
Grant Support: By the Northwestern University Feinberg School of Medicine (all authors). Drs. Williams and Hansen have received financial support from the John A. Hartford Foundation and the Society of Hospital Medicine for Project BOOST (Better Outcomes for Older Adults Through Safe Transitions). Dr. Young is supported by a National Research Service Award postdoctoral fellowship grant through the Institute for Healthcare Studies at Northwestern University under institutional awards from the Agency for Healthcare Research and Quality (T-32 HS 000078).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1422.
Requests for Single Reprints: Luke O. Hansen, MD, MHS, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, 07-733, Chicago, IL 60611; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Hansen: Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, 07-733, Chicago, IL 60611.
Dr. Young: Northwestern University Feinberg School of Medicine, 211 East Ontario Street, 7th Floor, Chicago, IL 60611.
Dr. Hinami: Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, 07-727, Chicago, IL 60611.
Dr. Leung: Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg 16-738, Chicago, IL 60610.
Dr. Williams: Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, 7th Floor, Chicago, IL 60611.
Author Contributions: Conception and design: L.O. Hansen, R.S. Young, M.V. Williams.
Analysis and interpretation of the data: L.O. Hansen, R.S. Young, K. Hinami, M.V. Williams.
Drafting of the article: L.O. Hansen, R.S. Young, K. Hinami, M.V. Williams.
Critical revision of the article for important intellectual content: L.O. Hansen, R.S. Young, K. Hinami, A. Leung, M.V. Williams.
Final approval of the article: L.O. Hansen, R.S. Young, K. Hinami, M.V. Williams.
Statistical expertise: L.O. Hansen, R.S. Young.
Administrative, technical, or logistic support: M.V. Williams.
Collection and assembly of data: L.O. Hansen, K. Hinami, A. Leung, M.V. Williams.
Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to Reduce 30-Day Rehospitalization: A Systematic Review. Ann Intern Med. 2011;155:520-528. doi: 10.7326/0003-4819-155-8-201110180-00008
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Published: Ann Intern Med. 2011;155(8):520-528.
About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days. Beginning in 2013, hospitals with high risk-standardized readmission rates will be subject to a Medicare reimbursement penalty.
To describe interventions evaluated in studies aimed at reducing rehospitalization within 30 days of discharge.
MEDLINE, EMBASE, Web of Science, and the Cochrane Library were searched for reports published between January 1975 and January 2011.
English-language randomized, controlled trials; cohort studies; or noncontrolled before–after studies of interventions to reduce rehospitalization that reported rehospitalization rates within 30 days.
2 reviewers independently identified candidate articles from the results of the initial search on the basis of title and abstract. Two 2-physician reviewer teams reviewed the full text of candidate articles to identify interventions and assess study quality.
43 articles were identified, and a taxonomy was developed to categorize interventions into 3 domains that encompassed 12 distinct activities. Predischarge interventions included patient education, medication reconciliation, discharge planning, and scheduling of a follow-up appointment before discharge. Postdischarge interventions included follow-up telephone calls, patient-activated hotlines, timely communication with ambulatory providers, timely ambulatory provider follow-up, and postdischarge home visits. Bridging interventions included transition coaches, physician continuity across the inpatient and outpatient setting, and patient-centered discharge instruction.
Inadequate description of individual studies' interventions precluded meta-analysis of effects. Many studies identified in the review were single-institution assessments of quality improvement activities rather than those with experimental designs. Several common interventions have not been studied outside of multicomponent “discharge bundles.”
No single intervention implemented alone was regularly associated with reduced risk for 30-day rehospitalization.
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Hospital Medicine, Prevention/Screening.
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